Grandiosity, the desire for praise, and a lack of empathy are characteristics of Narcissistic Personality Disorder (NPD). People with NPD also have problems maintaining work and relationships.

Current records on the prevalence of NPD vary between institutions, but the DSM IV study states approximately 6.2% of the population have NPD. Rates of NPD were also noted to be significantly greater among men than among women.

There are several causes for NPD. Some research has suggested that the disease is inherited. Negative psychosocial experiences, rejection as a kid, and a weak ego in early infancy may have caused the onset of NPD in adults. In contrast, excessive praise, like the conviction that a child could have extraordinary abilities, also can result in NPD.

Narcissists are grandiose, admiration-seekers who lack empathy. They are highly sensitive to criticism or defeat. Thus, they usually feel shame and humiliation which leads to withdrawal and depression. They can achieve great feats but their performance can be disrupted due to intolerance to criticism. They react with disdain, rage, and defiant counterattack. Narcissists may also have anorexia and substance use problems.

To diagnose NPD the patient must have at least five of the following:

• Overinflated sense of self-importance.
• Preoccupation with fantasies of success, power, brilliance, beauty, or perfect love;
• Feelings of superiority and desire to only associate with high-status people. 
• Excessive admiration is needed;
• Sense of entitlement;
• Opportunistic and uses others to advance their own goals;
• Lacks empathy and is unable to relate to others’ needs;
• Often feels envy of others or thinks others are envious of them;
• Arrogant or snobby behaviors and attitudes.

Additionally, some specialists use the Five-factor narcissism inventory or Narcissistic Personality Inventory to aid in the diagnosis of NPD. Lastly, psychotherapists use the Personality diagnostic questionnaire-4 (PDQ-4), Millon clinical multiaxial inventory III (MCMI-III), and the International personality disorder examination (IPDE) to understand how an NPD patient thinks and feels.

Treatment

The primary therapy for NPD is long-term counseling. It enables you to gain a better understanding of your problems and learn what changes you can do to relate to others positively, develop a positive self-image, and expect others to be more realistic.

There are no approved drugs for NPD yet, but doctors can prescribe drugs for anxiety and depression. Among these drugs are: antidepressants such as selective serotonin reuptake inhibitors; lithium to stabilize mood; and risperidone as an antipsychotic.

The chance of getting NPD is somewhat increased if a parent has it. However, this is only one of a number of causes of NPD. Consult a mental health expert if a family member may have NPD.

Counseling is the first step in controlling NPD. In this process, it is important to be open to changes. Counseling can help modify mental patterns, which in turn will influence behavior. These modifications can improve the quality of relationships and life over time.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Mitra P, Fluyau D. Narcissistic Personality Disorder. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556001/

Cleveland Clinic (2022). Narcissistic Personality Disorders. Retrieved October 21, 2022, from https://my.clevelandclinic.org/health/diseases/9742-narcissistic-personality-disorder.